结直肠癌筛查领域指南方法学质量的系统评价

Systematic review of the methodology quality and reporting quality in colorectal cancer screening guidelines

目的系统评价结直肠癌筛查指南的方法学质量和报告质量,为我国结直肠癌筛查指南的更新编写和结直肠癌筛查工作提供参考。方法以“结直肠癌”“结直肠肿瘤”“筛检”“筛查”“指南”“共识”“Colorectal cancer”“Colorectal neoplasms”“Screening”“Early Detection of Cancer”“Guideline”“recommendation”为检索关键词,系统检索PubMed、Embase、Web of Science、中国知网、万方数据知识服务平台、中国生物医学文献数据库、Cochrane图书馆、国际指南协作网(GIN)和中国临床指南文库(CGC)截至2018年4月前发表的所有中英文指南。同时检索美国预防服务工作组(USPSTF)、美国癌症学会(ACS)、国际癌症研究机构(IARC)、澳大利亚癌症委员会(ACC)、大不列颠及爱尔兰肛肠协会(ACPGBI)等机构官网刊登的指南作为补充。纳入标准为结直肠癌筛查的独立指南文件,语种限于中、英文;排除标准为关于指南的解读、评价、介绍等文献,以及指南翻译版本和旧版指南。采用欧洲指南研究与评估工具(AGREEⅡ)和实践指南报告标准(RIGHT)对结直肠癌筛查指南的质量和报告规范程度进行比较和评价。结果共纳入15篇指南。AGREEⅡ质量评价结果显示,15篇指南整体质量较高,其中整体得分达到≥50分以上者有9篇,推荐等级为A的有10篇,等级为B的有2篇,等级为C的有3篇;各指南在范围和目的、清晰性领域得分较高,在参与人员、严谨性、应用性和独立性领域得分差异较大。RIGHT评价结果显示,15篇指南报告质量有待提高,指南报告质量较差的6个条目分别为背景、证据、推荐意见、评审和质量保证、资金资助与利益冲突声明和管理及其他方面等。结论纳入的结直肠癌筛查相关指南的质量整体较高,但规范性有待加强。

Objective To systematically review the quality and reporting quality of colorectal cancer screening guidelines,and to provide reference for the update of colorectal cancer screening guidelines and colorectal cancer screening in China.Methods"Colorectal cancer","colorectal tumor","screening","screening","guide","consensus","Colorectal cancer","Colorectal neoplasms","Screening","Early Detection of Cancer","Guideline"and"recommendation"were used as search keywords.The literature retrieval for all the Chinese and English guidelines published before April 2018 was conducted by using PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Data,China Biology Medicine disc(CBMdisc),Cochrane Library,Guideline International Network,China Guidelines Clearinghouse(CGC)and the official website of the US Preventive Services Task Force(USPSTF),the American Cancer Society(ACS),International Agency for Research on Cancer(IARC),Australia Cancer Council(ACC)and Association of Coloproctology of Great Britain&Ireland(ACPGBI).The inclusion criteria were independent guidance documents for colorectal cancer screening.The language is limited to Chinese and English.The exclusion criteria were literature on interpretation,evaluation,introduction,etc.,as well as the translated version of the guide and old guides.The quality and reporting norms of colorectal cancer screening guidelines were compared and evaluated using the European Guideline Research and Assessment Tool(AGREEⅡ)and the Practice Guideline Reporting Standard(RIGHT).Results A total of 15 guides were included.The results of the AGREEⅡquality evaluation showed that the overall quality of 15 guides was high.Among them,there were 9 guides with an overall score of 50 or more,10 with a recommendation level of"A",and 2 with a rating of"B".There were 3 guides for"C";each guide scores higher in scope and purpose,and clarity,and scores vary greatly in the areas of participants,rigor,applicability,and independence.The results of the RIGHT evaluation showed that 15 guides were insufficient in six areas except for background information,evidence,recommendations,reviews and quality assurance,funding and conflict of interest statements and management,and other aspects.Conclusion The overall quality of included guidelines for colorectal cancer screening is high,but the normative nature needs to be strengthened.